Chapter 6: Nutritional Support My Nursing Test Banks

Chapter 6: Nutritional Support

Test Bank

MULTIPLE CHOICE

1. A patient is having complications from abdominal surgery and remains NPO. Because enteral tube feedings are not possible, the decision is to initiate parenteral feedings. What are the major complications for this therapy?

a.

Aspiration pneumonia and sepsis

b.

Fluid and electrolyte imbalances and sepsis

c.

Fluid overload and pulmonary edema

d.

Hypoglycemia and renal insufficiency

ANS: B

Because of the high dextrose concentration, including the fluid and electrolyte content, the patient is placed at high risk for sepsis and fluid and electrolyte imbalances. Aspiration pneumonia is a potential complication of enteral feedings; sepsis is a potential complication of parenteral nutrition. Fluid overload is possible but unlikely and is not a major complication of parenteral nutrition. Hyperglycemia is more of a concern than hypoglycemia with parenteral nutrition; however, renal insufficiency is not related to parenteral nutrition.

2. A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube. What is the primary reason the nurse must frequently assess tube placement?

a.

To assess for paralytic ileus

b.

To maintain the patency of the feeding tube

c.

To monitor for skin breakdown on the nose

d.

To prevent aspiration of the feedings

ANS: D

Patients who are on a ventilator and who are receiving tube feedings are at a high risk for aspiration and ventilator-associated pneumonia. Assessment of tube placement will neither determine presence of paralytic ileus nor maintain patency. Assessment of tube placement is performed to minimize aspiration risk, not skin breakdown on the nose.

3. The patient is to start parenteral nutrition. The nurse knows to prepare which site for catheter insertion?

a.

Basilic vein

b.

Femoral vein

c.

Radial artery

d.

Subclavian vein

ANS: D

Total parenteral nutrition is administered through a central intravenous line, such as the subclavian vein. Arteries are never used. The femoral site is avoided. The basilic vein is not a central site.

DIF: Cognitive Level: Application REF: p. 83

OBJ: Discuss practice guidelines related to nutritional support.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

4. A patient has been admitted to the critical care unit after a stroke. After failing a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step?

a.

Administer medications.

b.

Cap off and wait 24 hours before starting feedings.

c.

Obtain a chest radiograph.

d.

Start the tube feeding.

ANS: C

Correct placement must be verified by radiograph before use of the tube.

5. A patients feeding tube has been successfully placed in the small intestine with continuous flow tube feeding. The nurse knows that this approach was chosen because:

a.

intermittent feedings cause increased nausea and vomiting.

b.

the increased filling of the stomach increases absorption.

c.

the intestinal mucosa normally receives nutrients from the stomach in peristaltic waves.

d.

this will prevent malabsorption syndrome.

ANS: C

The small intestine usually receives nutrients from the stomach in peristaltic waves; this simulates normal peristalsis.

DIF: Cognitive Level: Analysis REF: p. 80

OBJ: Discuss practice guidelines related to nutritional support.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. A patient is being fed through a nasogastric tube placed in his stomach. The nurse would carry out which intervention to minimize aspiration risk?

a.

Add blue dye to the formula.

b.

Assess the residual every hour.

c.

Elevate the head of the bed 30 degrees.

d.

Provide feedings via continuous infusion.

ANS: C

The head of the bed should be kept elevated at least 30 degrees if possible during tube feedings to minimize reflux. Blue dye should not be used. Neither continuous feedings nor checking for residual will minimize aspiration.

DIF: Cognitive Level: Analysis REF: Table 6-4

OBJ: Discuss practice guidelines related to nutritional support.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7. A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. This is a concern because this most likely demonstrates that the patient has:

8. A patient is receiving enteral feedings and has just vomited 250 mL of milky green liquid. The nurse holds the tube feeding, which had been infusing at 100 mL/hr. The nurse knows that the next action should be:

a.

connect the feeding tube to suction.

b.

continue the tube feeding.

c.

decrease the tube feeding.

d.

recheck the residual in 2 hours.

ANS: D

The patient is not tolerating the tube feeding. It should be held until he has absorbed the remaining tube feeding. Feedings may resume when residuals are less than 250 mL.

11. A patient with acute pancreatitis is started on parenteral nutrition. The student nurse listed possible interventions for this patient. Which intervention needs correction before finalizing the plan of care?

a.

Change the intravenous tubing every 24 hours.

b.

Infuse antibiotics through the intravenous line.

c.

Monitor the blood glucose every 6 hours.

d.

Monitor the fluid and electrolyte balance.

ANS: B

Medications should not be infused through the IV line infusing parenteral nutrition.

DIF: Cognitive Level: Analysis REF: p. 89

OBJ: Discuss practice guidelines related to nutritional support.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. In evaluating a patients nutrition, the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism?

a.

Albumin

b.

BUN

c.

Prealbumin

d.

Triglycerides

ANS: C

Prealbumin is the most sensitive indicator of protein synthesis and catabolism.

17. In trauma patients, enteral nutrition via nasogastric tube feedings into the small bowel is best initiated within what time frame following the injury?

a.

24 hours

b.

48 hours

c.

7 days

d.

72 hours

ANS: A

Feedings into the small bowel are frequently initiated within 24 hours after the injuryor illness.

DIF: Cognitive Level: Application REF: p. 83

OBJ: Discuss practice guidelines related to nutritional support.

TOP: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

18. A patient with a history of emphysema, diabetes, and hyperlipidemia is in the critical care unit on a ventilator. The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight. Which formula for nutritional assessment is most appropriate?

Flushing the tubing every 4 hours helps prevent obstruction. Diluting tube feedings can cause water intoxication. Stylets are never used to clear a tube, and the smallest bore possible should be used for best tolerance.

Severely stressed individuals require 35 kcal/kg/day; 50 kcal/kg/day exceeds caloric needs. A total of 20 kcal/kg/day is less than normal caloric requirements. A total of 30 kcal/kg/day is the caloric requirement for a moderately stressed individual.

Hyperglycemia is common when receiving parenteral nutrition; insulin may be administered on a sliding scale for glucose control and/or added to the parenteral solution. Amount of insulin added to the parenteral solution is calculated based on the previous 24-hour laboratory values.

1. The correct order of actions for a patient starting enteral nutrition with a feeding tube is: _______________, _______________, _______________, _______________, _______________. (Put a comma and space between each answer choice.)

A. Initiate tube feeding.

B. Insert feeding tube.

C. Flush tube to verify patency.

D. Obtain chest radiograph.

E. Assess residuals.

ANS:

B, D, C, A, E

Initially the feeding tube will be inserted and final placement verified via chest radiograph. The next step is to flush the feeding tube and start the tube feedings. Residuals are checked every 4 hours.